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How to define cumulative cancer length for selecting candidate for active surveillance?
  1. Giorgio Ivan Russo,
  2. Giuseppe Morgia
  1. Department of Urology, University of Catania, Catania, Italy
  1. Correspondence to Dr Giorgio Ivan Russo, Department of Urology, University of Catania, Via Santa Sofia 78, Catania 95100, Italy; giorgioivan{at}

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In the recent time, active surveillance (AS) has gained popularity with the intention of avoiding or postponing interventions in subjects with low-risk prostate cancer (PCa), but several criticisms still exist.1 ,2

In this regard, the Prostate Cancer Research International: Active Surveillance (PRIAS) study showed the highest ability to identify patients with organ-confined PCa, with a receiver-operating curve (ROC) of 0.62.3 However, in the updated results from the PRIAS study, 27% of the cohort experienced disease reclassification at repeated biopsy (Bx) during follow-up.4

Currently available AS protocols failed in about 20% to identify men likely to harbour insignificant cancer from patients who had unfavourable tumour characteristics, which most probably should not be controlled by AS.5

These results confirmed that the risk of misclassification at the time of prostate biopsies still persists, a possibility that depends most likely from under sampling of more aggressive tumours than progression of apparent low-risk PCa.6

At the time of the initial decision to enrol in AS (baseline), many different factors have demonstrated utility at predicting future risk of progression, including upgrading or upstaging. These factors include prostate-specific antigen (PSA) density, %fPSA, prostate …

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  • Contributors GIR and GM: contributed to the intellectual content of this manuscript.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.